Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk
- Frits G.W. Cleveringa, MD1,
- Paco M.J. Welsing, PHD1,
- Maureen van den Donk, PHD1,
- Kees J. Gorter, PHD1,
- Louis W. Niessen, PHD2,3,4,
- Guy E.H.M. Rutten, PHD1 and
- William K. Redekop, PHD2
- 1Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands;
- 2Department of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands;
- 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
- 4School of Medicine, Policy and Practice, University of East Anglia, Norwich, U.K.
- Corresponding author: Frits G.W. Cleveringa, f.g.w.cleveringa{at}umcutrecht.nl.
Abstract
OBJECTIVE The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective.
RESEARCH DESIGN AND METHODS A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD− patients, respectively).
RESULTS Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (€1,415, P = NS), resulting in an ICER of €38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of €20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = €14,814) than for CVD− patients (ICER = €121,285). Coronary heart disease costs were reduced (€−587, P < 0.05).
CONCLUSIONS DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD.
Footnotes
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Clinical trial reg. no. ISRCTN21523044, www.clinicaltrials.gov.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received July 6, 2009.
- Accepted November 15, 2009.
- © 2010 by the American Diabetes Association.
